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Inspection on 26/07/07 for York Road (14a)

Also see our care home review for York Road (14a) for more information

This inspection was carried out on 26th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides people who plan to use the service and their representatives with all the information they need to make an informed decision about whether or not to move into the home however the Statement of Purpose needs to be updated. Provision is made so that people can attend appropriate social activities, day centres and become part of the local community. Appropriate arrangements are made so that people can have regular contact with their friends and families. One relative commented that she was impressed by the staff`s good manners, smart appearance and friendliness.

What has improved since the last inspection?

Significant efforts have been made and are being made by the registered manager and The Metropolitan Housing Association to improve the physical appearance of the home and to ensure that people live in a safe, homely and comfortable environment. The home has a new kitchen. Most of the staff team to attend training in Physical Intervention on the 12th of July 2007.

What the care home could do better:

A number of adult protection strategy meetings have been held at the offices of Sutton Social Services the local authority that has placed four people at the home. Following a high number of incidents of violence and aggression between people who use the service the placing authority was concerned that the homes strategies for protecting people had not been effective. The Commission met with managers from Mencap in June 2007 to discuss how Mencap would make sure that people living in the home could live in a safe environment. After reviewing the type of service that they can provide, Mencap managers felt that the service had done well in managing four of the six clients but in recent months had some difficulty in managing extreme challenging behavior. They felt that they could not guarantee the safety of the other four residents, but could run a four-person service with confidence. Sutton Social Services and Mencap have agreed that two people would be moved from the home by the 1st of September 2007. Mencap managers stated that once these two people had moved from the home they planned a period of consolidation and team building. The need was identified so as to stabilise the situation at the home. The Commission will continue to monitor the nature and frequency of any incidents occurring at the home. There were two requirements and four recommendations set at the last key inspection. The requirements have been met and the recommendations have been addressed. As a result of this inspection there are eight requirements and sixteen recommendations. The registered manager has a good track record of meeting requirements and recommendations set by the Commission and the inspector is confident that the requirements and recommendations set at this inspection will be addressed. Although the home is making positive progress at establishing a staff team and retaining staff, more could be done to offer people who use the service support in a consistent manner. Unless the whole staff team receives training and supervision appropriate to the work they are to perform, people who use the service cannot be sure that they are safe from risk of harm or abuse or that their needs will be met.As the home is considered to be a specialist challenging behaviour service that supports people with autism, challenging behaviour, mental health and some people use makaton to communicate the whole staff team should attend training on these topics. The manager could be more person centred in his approach and do more to make sure that the people who use the service are encouraged to get involved day-to-day running of their own home. The home could make sure that all people`s placement/needs assessments are kept under review. The home could contact the Speech and Language Therapy service for advice on communication. The home could contact Sutton Social Services Person Centred Planning Coordinater for advice and training on Person Centred Planning. The home would benefit from advice on storage and dispensing of medication from a pharmacist. The home could make sure that all members of staff attend food hygiene training. The home could make sure that weekly fire checks are carried out and recorded at the home. The home could consider options for appropriate garden furniture i.e. tables and benches cemented into the ground. So that people are supported in a consistent manner the home could select and small number of bank staff and attach them to the home. The inspector would like to thank people who use the service, their relatives, friends and health care professionals for completing the questionnaires and the staff and Mr. Sohawon for their support in the inspection process.

CARE HOME ADULTS 18-65 York Road (14a) 14a York Road Sutton Surrey SM2 6HG Lead Inspector James O’Hara Key Unannounced Inspection 26th July 2007 12:00p York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service York Road (14a) Address 14a York Road Sutton Surrey SM2 6HG 020 8643 9612 020 8643 1662 h4062@mencap.org.uk www.mencap.org.uk Royal Mencap Society Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Mohammad Iqbal Sohawon Care Home 6 Category(ies) of Learning disability (6) registration, with number of places York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th February 2007 Brief Description of the Service: 14a York Road is a purpose built facility situated in a mainly residential street, between Sutton and Cheam. The home is close to local transport and facilities. The Metropolitan Housing Association owns the building although the residential unit is managed and staffed by Mencap. The home provides care to six people who have learning disabilities, autism and challenging behaviour. There are six single bedrooms, a lounge, dining room, kitchen and laundry. There are bathrooms and toilets situated through out the home. The home also has a large garden to the rear of the property. There is also ample parking to the front of the house. The home has its own transport in the form of a people carrier. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was carried between 12noon and 4:30pm on a Thursday afternoon. Methods of inspection included a tour of the premises, observation of contact between staff and people who use the service and discussion with the registered manager Mr Iqbal Sohawon. Records examined included the homes Statement of Purpose, care plans/person centred plans, risk assessments, individual support strategies, medication, complaints, adult protection issues, recruitment and selection, staff personnel records, staff supervision, staff training, regulation 26 reports and health and safety and fire safety. A number of comment cards were returned to the Commission as feedback from people who use the service, their relatives and friends and health care professionals. Some of their comments are contained in this report. Requirements and recommendations from the previous inspection were also discussed with the registered manager. What the service does well: What has improved since the last inspection? Significant efforts have been made and are being made by the registered manager and The Metropolitan Housing Association to improve the physical appearance of the home and to ensure that people live in a safe, homely and comfortable environment. The home has a new kitchen. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 6 Most of the staff team to attend training in Physical Intervention on the 12th of July 2007. What they could do better: A number of adult protection strategy meetings have been held at the offices of Sutton Social Services the local authority that has placed four people at the home. Following a high number of incidents of violence and aggression between people who use the service the placing authority was concerned that the homes strategies for protecting people had not been effective. The Commission met with managers from Mencap in June 2007 to discuss how Mencap would make sure that people living in the home could live in a safe environment. After reviewing the type of service that they can provide, Mencap managers felt that the service had done well in managing four of the six clients but in recent months had some difficulty in managing extreme challenging behavior. They felt that they could not guarantee the safety of the other four residents, but could run a four-person service with confidence. Sutton Social Services and Mencap have agreed that two people would be moved from the home by the 1st of September 2007. Mencap managers stated that once these two people had moved from the home they planned a period of consolidation and team building. The need was identified so as to stabilise the situation at the home. The Commission will continue to monitor the nature and frequency of any incidents occurring at the home. There were two requirements and four recommendations set at the last key inspection. The requirements have been met and the recommendations have been addressed. As a result of this inspection there are eight requirements and sixteen recommendations. The registered manager has a good track record of meeting requirements and recommendations set by the Commission and the inspector is confident that the requirements and recommendations set at this inspection will be addressed. Although the home is making positive progress at establishing a staff team and retaining staff, more could be done to offer people who use the service support in a consistent manner. Unless the whole staff team receives training and supervision appropriate to the work they are to perform, people who use the service cannot be sure that they are safe from risk of harm or abuse or that their needs will be met. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 7 As the home is considered to be a specialist challenging behaviour service that supports people with autism, challenging behaviour, mental health and some people use makaton to communicate the whole staff team should attend training on these topics. The manager could be more person centred in his approach and do more to make sure that the people who use the service are encouraged to get involved day-to-day running of their own home. The home could make sure that all people’s placement/needs assessments are kept under review. The home could contact the Speech and Language Therapy service for advice on communication. The home could contact Sutton Social Services Person Centred Planning Coordinater for advice and training on Person Centred Planning. The home would benefit from advice on storage and dispensing of medication from a pharmacist. The home could make sure that all members of staff attend food hygiene training. The home could make sure that weekly fire checks are carried out and recorded at the home. The home could consider options for appropriate garden furniture i.e. tables and benches cemented into the ground. So that people are supported in a consistent manner the home could select and small number of bank staff and attach them to the home. The inspector would like to thank people who use the service, their relatives, friends and health care professionals for completing the questionnaires and the staff and Mr. Sohawon for their support in the inspection process. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides people who plan to use the service and their representatives with all the information they need to make an informed decision about whether or not to move into the home however the Statement of Purpose needs to be updated. No new people have moved to the home since the last inspection however all the procedures are in place should they be needed. EVIDENCE: The home has a Statement of Purpose and Service User Guide. The Service User Guide includes all the necessary information specified in regulation 5 of the Care Homes Regulations. However it is recommended that the Statement of Purpose be developed further to include more information on the homes objectives and philosophy and staff numbers and their experience and qualifications. The home currently supports six people with autistic spectrum disorder and a range of severe challenging behaviours. No new people have moved into the home since the last inspection. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 10 Mencap has its own guidelines for selecting and assessing people who wish to use the service. The home only accepts referrals following an assessment completed by a care manager. The home also completes its own assessment. Compatibility with others already living in the home is also taken into account. Any prospective people would have a gradual introduction to the home with a series of short visits and overnight stays. The time frame would be flexible depending on the person. The kitchen and laundry room doors are kept locked. The home Statement of Purpose was updated in December 2006 to include the reason for the restriction and how people can access the kitchen. These restrictions are included in the Service Users Guide but have yet to be discussed with individuals and recorded in their needs assessments/care plans. It is recommended that the reason for the restriction and how people can access the kitchen be discussed with individuals and recorded in their needs assessments/care plans. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service have plans that include information on their needs, likes and dislikes. The home could do more so that people are supported to take control of their own lives and encouraged to exercise their rights and make their own decisions and choices. The home could do more to make sure that people are encouraged to get involved day-to-day running of their own home. The home should move towards a person centred approach so that management and staff can listen to what people want from their lives, help people think about what they want now and in the future and help people plan their life the way they want to. EVIDENCE: One person’s personal file was examined. The file included support guidelines that included elements of Person Centred Planning. The file also included an York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 12 assessment support plan that considered his self-care, medication, meal preparation, domestic tasks, social skills and nighttime support. There was little reference to Equality and Diversity. So that the diverse needs of people who use the service are considered, care plans and person centred plans could include reference to how the service will meet their needs and preferences in relation to race, religion, gender, sexual orientation, age and disability. This person’s file included a behavioural support plan that focused on preventing and avoiding challenging behaviours and a positive handling plan that focused on situations when staff might need to use physical interventions. The file included risk assessments on accessing the community, bathing, cooking, self-injurious behaviour, using the kettle and sharp knives. The risk assessments were kept under regular review. The file included a health section with a record of health care appointments and medication reviews and a section on the person’s finances. The file also included this person last care manager’s placement/needs assessment review dated 2nd March 2006. In general information included in people’s files was comprehensive and included information on their needs, likes and dislikes and written intervention plans. Some staff had completed person centred planning training as part of the Mencap induction programme. However the registered manager explained that it was difficult to find out what some people would like to plan for the future as some people have difficulties with communication. It is recommended that the registered manager contact the Speech and Language Therapy service for advice on communication. It is recommended that the registered manager contact Sutton Social Services Person Centred Planning Co-ordinater for advice and training on Person Centred Planning. Two people placement reviews/needs assessments are due. The registered manager stated that he had recently been contacted by the duty social worker to arrange review dates but had yet to agree a suitable date. The registered manager stated that these would possibly take place in September. The registered manager must make sure that all people’s placement/needs assessments are kept under review. The registered manager stated that people who use the service do not hold meetings to discuss their concerns and wishes or about the day-to-day running of the home. The home does not seek the views of people through questionnaires. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 13 At present peoples views are considered using the homes key worker system. Again the registered manager explained that it was difficult to find out what some people would like as some people have difficulties with communication. In order that the people who use the service can be involved in the day to day running of the home and have an opinion of how the home provides care and support registered manager should consider how their views can be sought. This could be by enlisting the help of a facilitator to hold residents meetings or developing questionnaires with the support of the Speech and Language Therapy service. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Provision is made so that people can attend appropriate social activities, day centres and become part of the local community. Appropriate arrangements are made so that people can have regular contact with their friends and families. EVIDENCE: People attend various day services and colleges during the week and have a set home day when they carry out personal tasks such as cleaning, laundry, shopping and cooking. People attend the Jan Malinowski Centre, Cheam Centre, Hallmead Day Centre, Generates, Schola and Orchard Hill College’s. Some people also attend social activities at the Tuesday Club, Gateway Club and the Sunday Club. People are able to go to Church on Sunday if they wish and some people go to the cinema York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 15 and bowling. In house activities offered to people include arts and crafts and games. Some people are able to travel alone to Sutton for personal shopping or to visit cafes some people need support from staff to do this. All but one person has regular contact with their relatives. One person has an advocate/Mencap befriender. The registered manager stated that the befriender she has known the person for ten years. The home has visitor policy and the home just ask that visitors phone to ensure their family member is going to be in before they visit. Visitors are welcomed and people’s families are invited to their reviews. Visitors can be seen in any of the homes communal areas as well as in people’s bedrooms. A number of comment cards/questionnaires were returned to the Commission as feedback from relatives and friends of people who use the service and health care professionals. People who use the service were supported by staff to complete the questionnaires. Feedback from people was generally positive. All knew who to speak to if they were not happy. When answering the question “ Do you know how to make a complaint?” most people answered sometimes. All commented that staff treated them well and listen to them and act on what they say. It is recommended that the home develop a complaints procedure in a format that people understands. One relative commented that the home maintains consistent behaviour modification methods ensuring that their relative remains happy and calm. They added that the home could ensure that other resident’s behaviour is properly controlled at all times to minimise their relative’s anxiety when incidents occur. They were impressed by the staff’s good manners, smart appearance and friendliness. A comment card was returned to the Commission as feedback from an advocate/Mencap befriender of one person who lives at the home. These are a few of the befriender’s comments. Under the question. What do you feel the service does well? The befriender commented I only visit the home once a month so it is difficult to say but considering the starkness of the communal areas I think staff do well in supporting residents to make their bedrooms personal to their individual tastes. Under the question. How do you think the service can improve? The befriender commented I would like to see the residents become more involved in the dayto-day affairs of the home. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 16 Staff retention is a major problem in the home. Ongoing training for all staff would not only benefit the residents but also would add to everyone’s job satisfaction and lead to an overall improvement. Staff supports people to cook evening meals. The pre inspection questionnaire returned to the Commission included copies of menus for the weeks beginning 28/05/07 and 04/06/07. The menus indicated that people are offered cereal and toast every morning with a fried breakfast at the weekend, soup sandwiches and salad every lunchtime and more varied selection of cooked meals for the evening meal. The evening meals appeared to be balanced and nutritional. It is recommended that the home offer people who use the service a varied choice of meals for breakfast and lunch. The home could seek the advice of a dietician for planning menus for the home. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service receive personal support in the way they prefer. The homes policies and procedures for handling medicines ensure that people are so far as reasonably practicable protected from harm and/or abuse however the home would benefit from advice on storage and dispensing of medication from a pharmacist. EVIDENCE: A local pharmacist provides medication. Medication is obtained mainly in a blister pack system and is stored in a locked cabinet in the office. Medication administration records checked on the day of the inspection were up to date and accurate. It was observed that one person had eye drops dispensed in May 2006; the label stated that it should be discarded 28 days after opening. The registered manager was not sure of the date that it was opened or if it should still be in use. Although the registered manager produced evidence that all members of staff had attended medication training he agreed that the home would benefit York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 18 from advice on medication from a pharmacist. The registered manager must contact a pharmacist for advice on storage and dispensing of medication. The home currently supports six people with autistic spectrum disorder and a range of severe challenging behaviours. There have been a very high number of incidents involving violence and aggression between people who use the service. Information on strategies and intervention plans are included in people’s files. People’s files also included a health section with a record of health care appointments and medication reviews. It was noted that some members of staff had attended autism training, some members of staff had attended moving and handling training and three members of staff had attended training on Makaton. The registered manager must develop a training programme for the home that takes into consideration the physical and emotional health care needs of people who use the service. As Mencap considers this home to be a specialist challenging behaviour service that supports people with autism, challenging behaviour, mental health and some people use makaton to communicate the whole staff team should attend training on these topics. It is recommended that the registered manager contact the National Autistic Society for advice on autism. In a comment card completed by a General Practitioner the General Practitioner ticked the box marked yes to the following questions • • • • • • • • • Does the home communicate clearly and work in partnership with you? Is there a senior member of staff to confer with? Are you able to see patients in private? Does staff demonstrate an understanding of the care needs of service user? If you give any specialist advice is this incorporated into the service user plan? Is service users medication properly managed in the home? Do management/staff take appropriate decisions when they can no longer manage the care needs of the service user? Is the inspection report available to you on request? Are you satisfied with the overall care provided to service users within the home? The General Practitioner ticked the box marked no to the question • Have you received any complaints about the home? A comment card was completed by a psychologist and returned to the Commission as feedback. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 19 Under the question. What do you feel the service does well? The psychologist commented that staff had a high level of respect for clients, good written records, reports and files for clients, good supervision of staff and regular handovers and team meetings. Under the question. How do you think the service can improve? The psychologist commented reduce the number of clients in the home, improve staff continuity and retention, increase numbers of male staff and be more creative in the use of rooms and the garden. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. The home has an appropriate complaints procedure. However this could be developed in a format that all of the people who use the service understand. The home has suitable vulnerable adult protection and physical intervention strategies in place to make sure that people are so far as possible protected from abuse. EVIDENCE: Requirements were set at the last key inspection that the registered manager gives notice to the Commission without delay of the occurrence of any serious injury to people who use the service; and any event in the care home that adversely affects the well being or safety of any people who use the service and that the registered manager ensure that peoples individual care managers are given notice of any untoward incident involving their client. The home has forwarded copies of the occurrence of any serious injury to people who use the service to the Commission and individual care managers. The home has a protection of vulnerable adults file (POVA) that includes Mencaps, Sutton Social Services and Wandsworth Social Services adult protection procedures. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 21 The majority of staff has attended adult protection training and some staff is due to attend refresher training on the topic. It was noted that one nighttime member of staff last attended adult protection training in 2000. The home currently supports six people with autistic spectrum disorder and a range of severe challenging behaviours. There have been a very high number of incidents involving violence and aggression between some of people who use the service. The majority of these incidents have concerned two particular people however other people have been the victim of violence or been affected by these incidents. One of these violent incidents resulted in a person receiving a serious head injury that required hospital treatment. A number of adult protection strategy meetings have been held by Sutton Social Services the local authority that has placed four people at the home. The placing authority expressed its concerns that the home was failing to meet their clients assessed needs and that the homes strategies for protecting people have not been effective. Sutton Social Services have funded an extra staffing in the hope of eliminating or reducing the number of serious incidents of violence and aggression however the extra staffing has not had the desired effect. Sutton Social Services were concerned about the safety of their clients and in April 2007 they informed Mencap of their intention of finding a more suitable placement for one of their clients. The Psychology and Challenging Behaviour Services at Sutton carried out a challenging behaviour audit on The 27th June 2007. This was carried out at the request of Sutton Social Services over their concerns about the number of incidents reported at the home and in order to identify areas, which could be contributing to the difficulties, and to recommend service improvements. The psychologists report concluded that the number of residents was too high to offer a safe individualised responsive service within one house. Smaller units with for people with autism are always desirable as disorder results in major difficulties with social interaction and communication. The lack of relevant experience, qualifications and the high turnover of staff are all areas for concern. This is particularly so for clients with autism and/or challenging behaviour where continuity and consistency are paramount. The psychologist also made a number of other appropriate points/recommendations in her report. It is recommended that the registered manager consider all of the points/recommendations raised in the Psychology report. Due the frequency of serious incidents occurring at the home the Commission requested that senior managers from Mencap attend a meeting at the Commission office on the 13th of June 2007. The aim of the meeting was to York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 22 discuss how Mencap would make sure that people living in the home could live in a safe environment. Mencap felt that they had supported people successfully at this specialist challenging behaviour service for many years, but over recent months the behaviours of two people in particular had become increasingly challenging. A number of factors could have led to the increase in challenging behaviors; however the very high turnover of staff in 2005/6 may have been one of the major contributors. Seven experianced staff left over the period between December 2005 and September 2006. Although a number of staff had been recruited in October 2006 it has taken time to train them up. Since then one member of staff has left and a deputy manager has been promoted to a management position elsewhere in the organisation. After reviewing the type of service that they can provide, Mencap managers felt that the service had done well in managing four of the six clients but in recent months had some difficulty in managing extreme challenging behavior. Mencap considered that one particular client presented a serious threat to others, and unless there is a significant change following the withdrawal of the other person, they would be doing the other people living at the home a disservice by not considering moving him. They felt that they could not guarantee the safety of the other four residents, but could run a four-person service with confidence. During a telephone conversation with the registered manager on the 16th of May 2007 he stated that the home had set in place Guidelines for Managing Challenging Behaviour and a Physical Intervention Strategy. The Physical Intervention Strategy had been in place for two weeks and in that time there had been occasions when the use of physical intervention had prevented people being assaulted. The use of these interventions appeared to have a positive outcome for the people living in the home. He explained that staff had not had training on the use of Physical Intervention. He was advised that given the nature and frequency of the incidents and the risk of serious injury to people who use the service staff training on the use of Physical Intervention should considered a very high priority. The registered manager arranged for the staff team to attend training in Physical Intervention on the 12th of July 2007. The Physical Intervention Training was provided by, “Team Teach”. Team Teach are accredited by the British Institute for Learning Disability (BILD). It was noted that one night time member of staff did not receive training on physical intervention strategies. Mencap managers stated at the adult protection conference on the 5th of July that it was their intention to serve notice on one person living at the home. Mencap and Sutton Social Services agreed that two people would be moved from the home by the 1st of September 2007. Mencap managers stated that York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 23 once these two people had moved from the home they planned a period of consolidation and team building. The need was identified so as to stabilise the situation at the home. The registered manager stated that placement officers have recently visited the home to assess if these two people would be suitable for their services. The registered manager stated that he had arranged staggered holidays, trips and activities for these two people leading up to September in order to reduce the risk of further incidents and to keep people safe. The Commission will continue to monitor the nature and frequency of any incidents occurring at the home. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. Significant efforts have been made and are being made by the registered manager and The Metropolitan Housing Association to improve the physical appearance of the home and to ensure that people live in a safe, homely and comfortable environment. The overall impression when visiting this home is that it is generally well decorated, homely, comfortable, clean and hygienic. EVIDENCE: It was reported at the inspection on the 13th of November 2006 that the laminate flooring on the ground floor had been damaged due to flooding. The registered manager stated that new flooring would be laid on the 3rd of September 2007. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 25 It was reported at the inspection on the 13th of November 2006 that the kitchen was in a poor condition with some drawers missing from cupboards and flooring coming away from the walls. The kitchen has been replaced. It was reported at the inspection on the 13th of November 2006 that the kitchen floor was dirty around the base of the cupboards and fridge/freezer and that the doors to the kitchen and in the hallway were sticky to the touch and in need of washing down. The flooring in the kitchen has been replaced and the registered manager has made sure that the homes cleaning programme is adhered to. A requirement was set at previous inspections that the registered manager replaces the bulbs in the circular ceiling lights in the homes communal areas and investigate the reason why they have a short lifespan. A member of staff explained that The Metropolitan Housing Association has visited the home to carry out work on the homes lighting and was due to return. The registered manager stated that The Metropolitan Housing Association is better than the previous landlords at ensuring that repairs are carried out. At a recent inspection at 14b York Road another Mencap home the deputy manager expressed the same observations. During a tour of the premises it was noted that the back door leading to the garden was sticking and seating in some toilets were loose. The registered manager must ensure that the back door leading to the garden is repaired and loose toilet seating is tightened. The registered manager stated that a fire door in the hallway had come of its hinges. Immediately following this the registered manager carried out a workplace fire risk assessment. Workmen from the Metropolitan Housing Association came on the day of the inspection to fix the door. The living room had comfortable furniture. One person who lives at the home demonstrated how comfortable the settee was and had a lay down. The registered manager stated that this person had chosen this furniture for the home. However the registered manager agreed that the living room could do with repainting. It is recommended that the living room be redecorated and that people who use the service are involved in the choice of décor. The home has appropriate laundry facilities separate from the kitchen and the preparation of food. The washing machine is capable of washing clothes at high temperatures, which helps with the control of infections. The laundry has suitable flooring. There is a locked cupboard for the Control of Substances Hazardous to Health products. The home has one bathroom and one shower room, the registered manager stated that five out of the six people who use the service prefer using the bath and sometimes this can cause problems. The registered manager stated that York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 26 this issue might be resolved in September when two people move from the home. He was not sure if it was Mencaps intention to stay a four-person service after that. The home has a sensory room. The registered manager stated that a deputy manager had plans to develop this for some of the people who use the service. It was noted that the dining room has a large table but no chairs. The registered manager stated that this was because of the challenging behaviour presented by some of the people who use the service. He stated that people generally liked to use the kitchen table at meal times but would reassess the situation regarding the dining area again when the two people move from the home. The home has a large well-kept garden to the rear of the house however there is no garden furniture again the registered manager explained that this was because of the challenging behaviour presented by some of the people, throwing chairs over the fence. It is recommended that the registered manager consider options for appropriate garden furniture that people who use the service can enjoy in a safe manner i.e. tables and benches cemented into the ground. It was noted that the lighting is kept on all day in the house. There are no doors or window admitting natural light in the hallways on the ground floor or first floor of the home. The registered manager stated that as a result of this the home is always very warm and sometimes very uncomfortable. The registered manager stated that the area service manager had written to The Metropolitan Housing Association requesting that air conditioning is installed in the home. The registered manager is awaiting their response. He also stated that he would consider options for natural lighting but would need to discuss this with The Metropolitan Housing Association. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the home is making positive progress at establishing a staff team and retaining staff more could be done to offer people who use the service support in a consistent manner. Unless the whole staff team receives training and supervision appropriate to the work they are to perform, people who use the service cannot be sure that they are safe from risk of harm or abuse or that their needs will be met. EVIDENCE: At the last key inspection the registered manager stated that because of the nature of the service and the challenges it presented it had been difficult to retain staff. Seven staff had left over the period between December 2005 and September 2006. It was recommended that the Mencap organisation and registered manager consider how the home could establish a staff team that could meet the needs of people who use the service in the long term. The home is currently staffed by a registered manager, an acting deputy manager, four full time support workers and two night time staff, one of the night time staff works part time. A number of staff was recruited in October York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 28 2006, since then one member of staff has left and a deputy manager has been promoted to a management position elsewhere in the organisation. Another deputy manager is currently on maternity leave; the registered manager stated that she would soon be returning to work. The pre inspection questionnaire returned to the Commission indicated that the home has relied heavily on Mencaps Relief Bank and agency staff. The questionnaire indicated that home had used a total of thirty-three different people in the previous eight weeks. Following a number of adult protection strategy meetings Sutton Social Services had funded extra staffing in the hope of eliminating or reducing the number of serious incidents of violence and aggression at the home. The registered manager stated that this was funding was not agreed as a permanent arrangement so he was not able to recruit a full time member of staff and the extra staffing had been covered by bank and agency staff. However given the current client group and the challenges they present to the team it would seem very appropriate that they are supported by staff familiar with their needs and routines. It is recommended that the registered manager and the Mencap Relief Bank select and small number of bank or agency staff and attach them to the home. That way they can make sure that people who use the service are supported in a consistent manner. The registered manager explained that some of the Mencap Relief Bank that work at the home was previously employed full time there. Some had worked well with people in their time as support workers and had positive experience’s that could be passed on to the new members of staff. Although bank staff attends handovers it was suggested to the registered manager that the experianced bank staff should attend team meetings so that they could pass on their positive experiences and aid consistent working practices with people who use the service. One new member of staff started work since the last inspection. This person’s personnel file included two written references, proof of identification, Criminal Records Bureau Check, completed application form including a full employment history and a statement as to their mental and physical health. Staff training records was examined. Most staff attended training on adult protection, fire safety, first aid, moving and handling and medication. One of the nighttime staff has attended very little training. The registered manager agreed that during the night that this member of staff holds a great deal of responsibility and people who use the service and sleep over staffs health and safety and welfare would depend on her during the period that she is in charge of the home. As previously stated a number of staff started work at the home in October 2006. All of these staff attended a one week Mencap Induction Training York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 29 Course, the course included training on valuing people, key working, Person Centred Planning, health and safety awareness, risk assessments, report writing, medication, emotional disorders in learning disability, inclusion, understanding behaviours and team working. It was noted that none of the staff team had attended training on food hygiene. The registered manager stated that the food hygiene training was due to be completed by using a CD training pack however this has yet to be received at the home. The registered manager must make sure that all members of staff complete food hygiene training. Staff attended training in Physical Intervention on the 12th of July 2007. It was noted that one night time member of staff did not receive training on physical intervention strategies. The registered manager produced training material on active support (a skills teaching and support programme), he explained that was employed at the home on a previous occasion and had been beneficial to both the people who use the service and the staff team. It is recommended that the registered manager reintroduce active support training to the staff team. The registered manager stated that two members of staff have started an NVQ course and all other members of staff would be expected to apply for an NVQ course as they have now passed their probationary period. Staff supervision records indicated that all of the full time staff are receiving supervision on a regular basis however one night time staff has not had any supervision at all this year. The registered manager must ensure that all members of staff receive supervision on a regular basis. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 30 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The overall impression when visiting the home is that it is well managed, and the registered manager has a good track record of meeting requirements and recommendations set by the Commission, however the manager could be more person centred in his approach and do more to make sure that the people who use the service are encouraged to get involved day-to-day running of their own home. The manager needs to make sure that the whole staff team trained and supervised so that the team can meet the needs of people who use the service with confidence. EVIDENCE: York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 31 It was recorded at the last inspection that the registered manager was completing the Registered Managers Award and NVQ Level 4 in Care. The registered manager contacted the Commission in June 2006 stating that due to mitigating circumstances since September 2005 he has not been able to complete his NVQ 4 with Lewisham College. He stated that he would be starting the Registered Managers Award and NVQ Level 4 in Care again in September 2007. The registered manager agreed that he would write to the Commission indicating his plans to complete the Registered Managers Award and NVQ Level 4 in Care and his plans to continue training/developing himself as a manager. This letter has yet to be sent to the Commission. It is recommended that the registered manager write to the Commission indicating his plans to complete the Registered Managers Award and NVQ Level 4 in Care and his plans to continue training/developing himself as a manager. Copies of monthly Regulation 26 Visit reports were available in the home for inspection. It is no longer a requirement that copies of Regulation 26 Visit reports be sent to the Commission however the home should make the reports available for inspection. The registered manager produced a monthly continuous improvement plan/report. The plan/report looks at continuous improvement in a number of key areas such as health and safety, management systems, staffing, environment, resources and complaints. He stated that this information is passed to senior managers at Mencap so that they can monitor the service. The registered manager stated that questionnaires have been sent to people who use the service relatives for feedback about the service. This information is passed to the Mencap organisation and feedback to the home. The registered manager stated that he yet to receive feedback from Mencap on the questionnaires. The registered manager stated that there are no such questionnaires given to people who use the service at present. A requirement has been set in the “Individual Needs and Choices” section of this report that in order that the people who use the service can be involved in the day to day running of the home and have an opinion of how the home provides care and support registered manager should consider how their views can be sought. At the last key inspection the registered manager stated that a Portable Appliance Test had been carried out in 2006 and that he had requested a copy of the certificate. He stated that Mencaps policy for Portable Appliance Testing is that it is carried out once every two years. It was recommended as good working practice that Portable Appliance Testing is carried out annually. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 32 Following the key inspection the Commission requested information on Mencaps Health and Safety Departments Portable Appliance Testing procedures the registered manager forwarded the Health and Safety Executives leaflet on maintaining portable electrical equipment in offices and other low risk environments. It is recommended that the registered manager forward Mencaps corporate policy on Portable Appliance Testing to the Commission. The fire alarm system is tested quarterly by engineers and was last tested on the 25/07/07. Fire records indicated gaps in weekly fire safety checks. The registered manager must ensure that weekly fire checks are carried out and recorded at the home. Full fire evacuation drills were carried out in February and July 2007. The home has a fire risk assessment that is updated when required. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 14 (2) a Requirement Timescale for action 30/10/07 2. YA7 3. YA20 4. YA32 The registered manager must make sure that all people’s placement/needs assessments are kept under review. 4 (1) c, In order that the people who Schedule 1 use the service can be involved of the Care in the day to day running of the Homes home and have an opinion of Regulations. how the home provides care and support registered manager should consider how their views can be sought. 13 (2) The registered manager must contact a pharmacist for advice on storage and dispensing of medication. 18 (1) c (i) The registered manager must develop a training programme for the home that takes into consideration the physical and emotional health care needs of people who use the service. As Mencap considers this home to be a specialist challenging behaviour service that supports people with autism, challenging behaviour, mental health and some people use makaton to communicate the whole staff team should attend training on DS0000007149.V346431.R01.S.doc 30/10/07 30/09/07 30/10/07 York Road (14a) Version 5.2 Page 35 these topics. 5. YA32 18 (1) c (i) The registered manager must make sure that all members of staff complete food hygiene training. The registered manager must ensure that the back door leading to the garden is repaired and loose toilet seating is tightened. The registered manager must ensure that all members of staff receive supervision on a regular basis. The registered manager must ensure that weekly fire checks are carried out and recorded at the home. 30/09/07 6. YA24 23 (4) b & 13 (4) c. 29/07/07 7. YA36 18 (2) 30/10/07 8. YA42 23 (4) c 29/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations It is recommended that the Statement of Purpose be developed further to include more information on the homes aims and objectives and staff numbers, experience and qualifications. It is recommended that the reason for the restriction and how people can access the kitchen be discussed with individuals and recorded in their needs assessments/care plans. It is recommended that the registered manager contact the Speech and Language Therapy service for advice on communication. It is recommended that the registered manager contact Sutton Social Services Person Centred Planning Coordinator for advice and training on Person Centred Planning. It is recommended that the registered manager reintroduce active support training to the staff team. It is recommended that the home develop a complaints DS0000007149.V346431.R01.S.doc Version 5.2 Page 36 2. YA6 3. 4. YA6 YA6 5. 6. YA32 YA22 York Road (14a) 7. 8. YA23 YA17 9. 10. YA24 YA24 11. 12. YA19 YA32 13. YA32 14. YA37 15. 16. YA42 YA42 procedure in a format that people who use the service can understand. It is recommended that the registered manager consider all of the points/recommendations raised in the Psychology report. It is recommended that the home offer people who use the service a varied choice of meals for breakfast and lunch. The home could seek the advice of a dietician for planning menus for the home. It is recommended that the living room be redecorated and that people who use the service are involved in the choice of décor. It is recommended that the registered manager consider options for appropriate garden furniture that people who use the service can enjoy in a safe manner i.e. tables and benches cemented into the ground. It is recommended that the registered manager contact the National Autistic Society for advice on autism. It is recommended that the registered manager and the Mencap Relief Bank select and small number of bank staff and attach them to the home. That way they can make sure that people who use the service are supported in a consistent manner. It is recommended that the experianced bank staff attend team meetings so that they can pass on their positive experiences and aid consistent working practices with people who use the service. It is recommended that the registered manager write to the Commission indicating his plans to complete the Registered Managers Award and NVQ Level 4 in Care and his plans to continue training/developing himself as a manager. It is recommended as good working practice that Portable Appliance Testing is carried out annually. It is recommended that the registered manager forward Mencaps corporate policy on Portable Appliance Testing to the Commission. York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI York Road (14a) DS0000007149.V346431.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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